Høvik Lise Husby, Aglen Bjørg, Husby Vigdis Schnell
Clinic of Anaesthesia and Intensive Care Medicine, Trondheim University Hospital, Trondheim, Norway.
Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.
Scand J Caring Sci. 2018 Jun;32(2):833-842. doi: 10.1111/scs.12514. Epub 2017 Aug 23.
Total knee arthroplasty is experienced as a painful procedure, and pain after surgery seems to be the most limiting factor for early mobilisation. Physical exercise is of utter importance for avoiding complications such as persistent pain and functional limitations. A fast-track pathway aims at improving patient outcome, and patients are now discharged 2-3 days after surgery. Little is known about how the patients cope with pain, exercise or daily activities at home.
To explore the experience of patients undergoing total knee arthroplasty in a fast-track pathway during the first 2 weeks after surgery.
Qualitative design.
Three focus group interviews, including 13 patients from two different units of an orthopaedic department in central Norway, were conducted from May to June 2015. The interviews were analysed using Malteruds` method of systematic text condensation.
The main finding was the patients' determination and ability to cope at home. The fast-track pathway seemed to enable patients to take an active role in own self-care. The patient's coping capacity was strengthened by education, knowledge and predictability. Four main areas related to coping emerged after discharge. First, the majority of patients expressed that it was good to come home and take responsibility for their own rehabilitation. Second, prerequisites for feeling secure after returning home were highlighted. Third, the patients seemed empowered by sharing experiences with others. Fourth, postoperative pain was prevalent in many patients after discharge, but the patients seemed prepared by information provided in the fast-track pathway.
The fast-track pathway released coping skills and resources among the patients. The expectation of, and preparation for early discharge made the patients feel confident when discharged few days after surgery. The patients expected to take great responsibility for their own rehabilitation process.
全膝关节置换术是一种痛苦的手术，术后疼痛似乎是早期活动最主要的限制因素。体育锻炼对于避免诸如持续疼痛和功能受限等并发症至关重要。快速康复路径旨在改善患者预后，目前患者术后2至3天即可出院。对于患者在家中如何应对疼痛、锻炼或日常活动知之甚少。
探讨在快速康复路径下行全膝关节置换术的患者术后前两周的经历。
质性研究设计。
2015年5月至6月，对挪威中部某骨科两个不同科室的13名患者进行了三次焦点小组访谈。采用马尔特鲁德的系统文本浓缩法对访谈进行分析。
主要发现是患者在家中的决心和应对能力。快速康复路径似乎使患者能够在自我护理中发挥积极作用。教育、知识和可预测性增强了患者的应对能力。出院后出现了与应对相关的四个主要方面。第一，大多数患者表示回家并对自己的康复负责很好。第二，强调了回家后感到安心的前提条件。第三，患者似乎通过与他人分享经验而获得了力量。第四，许多患者出院后仍普遍存在术后疼痛，但快速康复路径提供的信息似乎让患者有所准备。
快速康复路径释放了患者的应对技能和资源。对早期出院的期望和准备使患者在术后几天出院时感到自信。患者期望对自己的康复过程承担重大责任。
